Pre- Authorization Representative

OrthoSC; Myrtle Beach (SC); On-site; USD 21,000 - 29,000; Full time

Job summary

OrthoSC in Myrtle Beach, SC is seeking a Pre-Authorization Representative to manage pre-certification and scheduling for procedures. The role requires coordinating with insurers, patients, and providers to obtain necessary approvals and communicate expected costs.

Responsibilities include handling insurance benefits, maintaining accurate records, and ensuring compliance with company policies. A high school diploma and healthcare exposure are preferred.

Qualifications

• High School Diploma or equivalent required.
• Minimum of 2 years of physician office and/or healthcare experience.
• Strong communication and organizational skills.

Responsibilities

• Obtain insurance pre-certification and pre-authorization with necessary documents and authorization for payment for surgeries and non-surgical procedures, referrals, medical equipment, medications, and therapies
• Make phone calls to insurance companies, patients, and other facilities.
• Maintain accurate chart documentation.
• Interact directly with doctors in our office and other offices and hospitals.
• Prepare information for patient and communicate this information to the patient.
• Assist patients in understanding their insurance benefits and estimated amount due for scheduled procedures.
• Maintain compliance with all company policies and procedures.
• Other duties as assigned.

Skills

Orthopaedic/general medical terminol.

Computer proficiency

Professional demeanor

Respect and follow physician/patientEt

Work under pressure with a positiveAtt

Excellent verbal and written comm.

Education

High School Diploma or equivalent

Job description

• Base Pay $15.33 - $20.75 / Hour
• Required Degree High school

Summary/Objective

The Pre-Authorization Representative is responsible for the company’s pre-certification and scheduling department. This position will oversee all aspects of the precertification and pre-authorization activities within OrthoSC.

Essential Functions

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Obtain appropriate benefits for surgical and non-surgical procedures, referrals, medical equipment, medications, and therapies ordered by providers.
• Obtain insurance pre-certification and pre-authorization with necessary documents and authorization for payment for surgeries and non-surgical procedures, referrals, medical equipment, medications, and therapies
• Make phone calls to insurance companies, patients, and other facilities.
• Maintain accurate chart documentation.
• Interact directly with doctors in our office and other offices and hospitals.
• Prepare information for patient and communicate this information to the patient.
• Assist patients in understanding their insurance benefits and estimated amount due for scheduled procedures.
• Maintain compliance with all company policies and procedures.
• Other duties as assigned.

Competencies

• 1. Orthopaedic/general medical terminology
• 2. Computer proficiency
• 3. Professional demeanor
• 4. Respect and follow physician/patient etiquette
• 5. Work under pressure with a positive attitude
• 6. Excellent verbal and written communication skills

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

While performing the duties of this job, the physical activity is intended to describe the general nature and level of work being performed by individuals assigned to this position. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.

Position Type and Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Thursday, 8:00 a.m. to 5 p.m., Fridays from 8:00 a.m. to 2:00 p.m.

Travel

No travel is expected for this position.

Education and Experience

• 1. High School Diploma or equivalent
• 2. Minimum of 2 years of physician office and/or healthcare experience.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.